Tailoring African American Faith Community-Based Diabetes Self-Management Education.

ABSTRACT: African Americans (AA) experience a disparate effect of type II diabetes (T2D). For this nurse-led pilot study, a pre-validated 6-week diabetes self-management education (DSME) program was implemented in a faith community setting and tailored to the participants' faith and culture by using short scriptural lessons, prayers, and individual sharing. Participants demonstrated improvements in fasting blood glucose (p = .042), diabetes knowledge (p = .002), and psychosocial self-efficacy (p = .001). Although generalizability of findings is limited, the structure and methods used in tailoring this DSME program could be transferable to other faith-based settings.

Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital.

AIM: Is it feasible to implement a programme to screen for depression in patients admitted to the hospital for diabetes complications and use the electronic medical record to notify providers of their patient's depression score and give suggestions for medication and counselling? DESIGN: A feasibility study was conducted with patients hospitalized with diabetes and depression in the Durham Veterans Affairs Medical Center, Durham, North Carolina, United States. METHODS: Patients with type 2 diabetes were screened for depression. The healthcare provider was notified via the electronic medical record about the patients' depression scores. The provider discussed options for management of depression with the patient and initiated treatment. RESULTS: The process of screening for depression at admission, notifying the provider by way of electronic medical record that the patient screened positive for depression with suggestions for medication and counseling was feasible and acceptable to providers and patients.

Management of type 2 diabetes in Asian Indians: a review of the literature.

Type 2 diabetes mellitus (T2DM) is increasing in Asian Indians globally. In this article, we review published studies of interventions designed to prevent T2DM or improve self-management in South Asian Indians. A PubMed, CINAHL, Medline, EMBASE, Psycinfo, Family & Society Studies Worldwide, Web of Science, and Consumer Health Complete search was conducted using the following search terms: type 2 diabetes mellitus, Asian Indian continental ancestry group, therapy, treatment, management, care, intervention, self-care, exercise, diet, and lifestyle. The review included pilot or full intervention studies examining the prevention and/or management of T2DM and qualitative studies analyzing the influence of various ethnic factors on the prevention and management of T2DM. Seventeen studies met the inclusion criteria. They examined the influence of culture and religion and the effectiveness of individual and community-based education and lifestyle improvement programs, exercise, and complementary therapies. Few programs led to the improved long-term management of T2DM. Further research is needed to develop ethnic-specific interventions.

Cancer survivorship care: Implications for primary care advanced practice nurses.

Cancer survivors are at risk for recurrences, new cancers, and late and long-term effects of cancer treatments. Health promotion and management of comorbid conditions remain a standard of care for cancer survivors. Nurse practitioners should collaborate with oncology specialists using a shared-care model in delivering survivorship care.

The Pediatric Obesity Initiative: development, implementation, and evaluation.

PURPOSE: Pediatric obesity rates have nearly tripled over the past three decades contributing to increased morbidity and mortality in the United States and around the world. Pediatric obesity is most prevalent in developed countries and affects all races, ethnicities, cultures, and age groups. To combat this epidemic locally, a team of dedicated providers developed a comprehensive evidenced-based toolkit and training program for clinical practices providing primary care services to children in a North Carolina county. DATA SOURCES: The toolkit and training program were developed using the most current treatment guidelines for pediatric obesity and included resources developed by Healthy Carolinians. One unique feature of the training was a demonstration of motivational interviewing with additional resources included in the toolkit. CONCLUSIONS: Staff and providers in three pediatric practices and the local Health Department received the training. In a 3 months follow-up survey after the training, the providers indicated that the toolkit and training program were useful but that they still did not consistently use the guidelines or tools. IMPLICATIONS FOR PRACTICE: Ensuring the use of available guidelines and resources by providers remains a challenge. Further study is needed on how to improve implementation of guidelines in primary care settings.

The association between acanthosis nigricans and dysglycemia in an ethnically diverse group of eighth grade students.

OBJECTIVE: The purpose of this study was to describe the prevalence of acanthosis nigricans (AN) and to quantify its association with dysglycemia in an ethnically diverse group of eighth-grade students. DESIGN AND METHODS: Data were collected in 2003 from a cross-sectional study of students from 12 middle schools in three US states. Sex, race/ethnicity, and pubertal status were self-reported. Anthropometric measures were recorded. Trained staff identified the presence and severity of AN by inspection of the back of the neck. Fasting and 2 h blood samples were analyzed for impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and high-risk glycated hemoglobin (A1C), respectively, defined as ≥100 mg/dl, ≥140 mg/dl, and ≥ 5.7-6.4%. RESULTS: Overall, 25.0%, 58.2%, and 16.8% were Black, Hispanic, and White, respectively. AN was present among 406/1,438 (28.2%) of students: 39% among Black, 30% among Hispanic, and 5.4% among White. IGT and high-risk A1C were present among 2.1%, and 12.4%, respectively. In multivariate logistic modeling after adjusting for gender, family history of diabetes, BMI percentile, and pubertal staging, the presence (vs. absence) of AN was associated with a 59% increased likelihood of high-risk A1C: (P = 0.04), twice the likelihood of IGT (P = 0.06), and 47% greater likelihood of IGT/IFG combined (P < 0.0001). Adjustment for insulin attenuated the ORs by 25-70%. CONCLUSION: In a racially/ethnically diverse sample of US adolescents, AN was common, occurring in 28% of the sample. AN was associated with a 50-100% increased likelihood of dysglycemia even after consideration of established diabetes risk factors.

Student public commitment in a school-based diabetes prevention project: impact on physical health and health behavior.

BACKGROUND: As concern about youth obesity continues to mount, there is increasing consideration of widespread policy changes to support improved nutritional and enhanced physical activity offerings in schools. A critical element in the success of such programs may be to involve students as spokespeople for the program. Making such a public commitment to healthy lifestyle program targets (improved nutrition and enhanced physical activity) may potentiate healthy behavior changes among such students and provide a model for their peers. This paper examines whether student's "public commitment"--voluntary participation as a peer communicator or in student-generated media opportunities--in a school-based intervention to prevent diabetes and reduce obesity predicted improved study outcomes including reduced obesity and improved health behaviors. METHODS: Secondary analysis of data from a 3-year randomized controlled trial conducted in 42 middle schools examining the impact of a multi-component school-based program on body mass index (BMI) and student health behaviors. A total of 4603 students were assessed at the beginning of sixth grade and the end of eighth grade. Process evaluation data were collected throughout the course of the intervention. All analyses were adjusted for students' baseline values. For this paper, the students in the schools randomized to receive the intervention were further divided into two groups: those who participated in public commitment activities and those who did not. Students from comparable schools randomized to the assessment condition constituted the control group. RESULTS: We found a lower percentage of obesity (greater than or equal to the 95th percentile for BMI) at the end of the study among the group participating in public commitment activities compared to the control group (21.5% vs. 26.6%, p = 0.02). The difference in obesity rates at the end of the study was even greater among the subgroup of students who were overweight or obese at baseline; 44.6% for the "public commitment" group, versus 53.2% for the control group (p = 0.01). There was no difference in obesity rates between the group not participating in public commitment activities and the control group (26.4% vs. 26.6%). CONCLUSIONS: Participating in public commitment activities during the HEALTHY study may have potentiated the changes promoted by the behavioral, nutrition, and physical activity intervention components. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00458029.

Changing our future: obesity and the metabolic syndrome in children and adolescents.

Obesity, or overweight, in childhood is a major risk factor for the metabolic syndrome in adolescence, as the prevalence in US children tripled between 1970 and 2000. An increase in the metabolic syndrome in youth has followed this increase. In population-based studies, the prevalence of the syndrome ranged from 3.6% to 4.2%. In smaller studies with many overweight youth, the prevalence was 28.7% to 39.7% in those who were overweight and 49.7% in those who were severely obese. Overweight children are likely to have hyperinsulinemia, high-density lipoprotein cholesterol, high triglycerides, and hypertension, which are components of the metabolic syndrome. Nurses have an important role in screening for these metabolic syndrome components. Screening is especially important in boys and girls who are overweight and in girls with early menarche. A problem when screening children and adolescents is determining normative values, but guidelines are available. Prevention and management of the metabolic syndrome are not specific to the syndrome, but rather should be focused on the underlying problem of overweight and related problems that comprise the syndrome. We must use all avenues available to us, including influencing public and school policies, and pay close attention to overweight and metabolic syndrome components in our clinical practice, whether with children or adults. Preventing and managing the metabolic syndrome should be a family matter, and the necessary lifestyle changes will benefit the entire family.